2019 Mississippi Education and Certification Program 
Track II Designations
Important Note 
If you have a change in name, contact information, or employer please notify GCD immediately by email: jason.camp@msstate.edu
Designation *
AEI Requirement Check Off *
AEII Requirement Check Off *
MAE Requirement Check Off *

Designation Fee-$50.00 each

Retake Fee-$25.00

 The Application Fee must be received by GCD no later than May 31, 2019, to be considered.

Checks made payable to:
Center for Government and Community Development 
Attn: Track II Designation
Box 9643
Mississippi State, MS 39762
Special Accommodations:
If you require any special accommodations to participate in this event, please contact Jason Camp at 662-325-3141 or jason.camp@msstate.edu